From the Hill
Accreditation: Another Hurdle Facing O&P
By Tim Redmon
Exclusive to the O&P Almanac
Most O&P professionals are aware that competitive bidding will become a reality in some regions of the country beginning in 2007.
But, many are not fully aware that lawmakers also included two additional provisions in the Medicare Modernization Act of 2003 that will impact any entity seeking Medicare payment for O&P and durable medical equipment.
These provisions include mandatory facility accreditation and the establishment of new Medicare supplier standards. Both are inextricably linked to the implementation of a competitive bidding program.
Policymakers linked accreditation with competitive bidding because they felt this would ensure quality patient care and might cut down on fraud and abuse.
These are worthy goals, but some O&P professionals are concerned because the accreditation requirements will involve additional expense and could pose a significant financial challenge, especially to small suppliers.
Timeline
To date, no exact timeline for compliance with these new requirements has been set. However, the legislation establishing them lays out some general parameters for their implementation.
According to the legislation, Medicare is authorized to establish new quality standards after consulting with "relevant parties" by program memorandum. This is disconcerting, since it does not allow for official public comment—the standards will simply go into effect once they are published on Medicare's Web site.
Next, the agency plans to issue a regulation explaining how accreditation organizations apply for "deemed status," which means they will be recognized by Medicare as an official accrediting body. Within a year after the new supplier standards have been published, Medicare will designate one or more independent accreditation organizations.
Here's the timetable we expect:
Final quality standards are expected this summer.
Medicare will publish a list of accrediting organizations with "deemed status" by the end of this year.
After that, suppliers accredited by any of the Medicare-approved accrediting organizations would, in turn, be deemed able to meet Medicare's quality standards.
These new quality standards would be enforced by the various accrediting bodies.
Officials from the Centers for Medicare and Medicaid Services noted that quality standards will address organizational structure, financial management, human resources, patient management, assessment and evaluation of quality, facility and patient environment and safety management, ethics/rights and information management.
It is likely, but by no means certain, that Medicare will not require every supplier to become accredited immediately.
Currently, more than 130,000 entities have a Medicare supplier number. Forcing every one of them to become accredited in a short period of time is likely to be unmanageable for any accreditation body. Thus, Medicare may implement some form of staggered accreditation.
How it might work
The competitive bidding program will be implemented on Jan. 1, 2007, in 10 of the largest metropolitan statistical areas across the country. One way that Medicare might approach mandatory accreditation is to require facilities in these areas to be accredited first.
This is just a guess. But, if it comes to pass, the timeline is extremely compressed. It is entirely conceivable that a facility would need accreditation as early as spring or summer 2006.
And, accreditation isn't optional. Medicare will require all facilities in a location where competitive bidding is taking place to be accredited, whether they are participating or not.
Status
Medicare's goal is to issue a proposed rule on the design and implementation of competitive bidding by late this summer and then publish a final rule sometime in 2006. This will provide information about where the program will take place and set the rules to participate in the competitive bidding process.
In 2007, 10 of the largest metropolitan statistical areas will have competitive bidding for all durable medical equipment and "off-the-shelf" orthotic devices. In 2008, this will increase to 80 of the largest metropolitan statistical areas. And in 2009, the rest of the country will fall under the competitive bidding program.
As of this writing in May, Medicare has not yet determined what orthotic devices will fall under the "off-the-shelf" category.
Why?
By using accreditation and new quality standards, the government wants to ensure quality and eliminate Medicare fraud.
Unfortunately, it appears that many legitimate suppliers that provide quality services in compliance with existing Medicare rules will be forced to incur significant additional costs in order to maintain their supplier status.
In addition to the financial impact that these new requirements will have, an equally important concern may be ensuring that the government allows adequate time for existing suppliers to obtain accreditation before the compliance deadline passes.
The designated accreditation organizations will have the responsibility of surveying the suppliers to ensure compliance. An accreditation survey is a time-consuming process. Therefore, unless Medicare allows adequate time for compliance or implements some type of grandfathering provision during the time between the request and actual survey, some suppliers could find themselves at risk.
Currently, the ABC facility accreditation process can be completed, in most cases, in less than two months. However, this process may become protracted simply because of increased demand.
What can you do now?
Since Medicare has not identified new supplier standards or accreditation entities, O&P professionals are put in an extremely difficult situation. It is impossible to be in compliance with important requirements that currently do not exist.
The answer is to remain vigilant and proactive. Suppliers should not wait for the accreditation and quality standards to be published before looking at current O&P accreditation standards.
However, once Medicare outlines the new quality standards and selects the organizations that can accredit facilities, O&P professionals should take steps to become compliant immediately.
Tim Redmon is the manager of regulatory affairs for AOPA.
